Acute Care/ICU/Post-Surgical

Pulmonary complications arising from transient impairment of mucociliary clearance and cough function are common in post-surgical/acute care patients. Retained secretions promote development of atelectasis, bronchopulmonary infections, pneumonia and respiratory failure. Such complications are a major factor in driving up total healthcare costs, especially in terms of intensive care unit utilization.

  1. Allen JS, Garrity JM, Donohue DM. The utility of high-frequency chest wall oscillation therapy in the post-operative management of thoracic patients. Abstract: Control/Tracking Number: 03-A-732-ACCP, 2003.
    
In a safety and tolerance assessment of high frequency chest wall oscillation (HFCWO) in post-operative secretion management, 25 elective thoracic surgical patients received HFCWO as soon as 24 hours after surgery. Pre and post HFCWO treatment, hemodynamic and pulse oximetric values remained stable; 84% of patients tolerated and accepted the therapy; no major adverse events were observed. HFCWO may be a safe, cost-effective intervention for prevention or management of post-operative pulmonary complications for appropriately selected patients.
  2. al-Saady NM, Fernando SS, Petros AJ, Cummin AR, Sidhu VS, Bennett ED. External high-frequency oscillation in normal subjects and in patients with acute respiratory failure. Anaesthesia 1995; 50:1031-1035.

    
Twenty healthy volunteers treated with an external chest wall oscillation (ECWO) device (the Hayek Oscillator) demonstrated significant improvement in lung ventilation. Effective ventilation was measured in terms of the fall in alveolar PCO2 immediately after oscillation. In the same study, ECWO was compared with intrapulmonary positive pressure ventilation (IPPV) in five patients with respiratory failure. After a 30 minute treatment with IPPV, therapy was replaced with 30 minutes of ECWO. Oxygenation improved by 16% and PCO2 decreased by 6%, indicating that ECWO can maintain adequate ventilation is this group of patients.
  3. Brierley S, Adams C, Suelter J, Gooch T, Becker B. Safety and tolerance of high-frequency chest wall oscillation (HFCWO) in hospitalized critical care patients. Respir Care 2003; 48 (11): 1112.

    
In an observational study of the safety and tolerance of high frequency chest wall oscillation (HFCWO) therapy in acute care patients, 73 critical care/post-surgical patients were treated with HFCWO concurrently with therapies or equipment including 1) sternal incision/sternal wires (n = 48); 2) chest tubes (n=24); 3) external pacer wires (n=30) ; 4) swan-ganz catheters (n =27); 5) penrose drains (n= 23); 6) central venous pressure lines (n=21); 7) implanted cardiac pacemakers (n= 11); 8); CPAP (n= 5); 9) mechanical ventilation (n=1);10) internal cardiac defibrillator (n =1).  A total of 179 therapy days were evaluated.  HFCWO was well tolerated by 84% of users; 16% discontinued citing discomfort. No significant adverse events were reported. With appropriate care, HFCWO use in this patient population appears to be safe, well-tolerated and unlikely to dislodge or disrupt invasive or sensitive equipment.
  4. Chiappetta A, Mendendez A, Gozal D, Kiernan M. High-frequency chest wall oscillation in hospitalized non-cystic fibrosis patients. Am J Respir Crit Care Med 1996; 153:A566.
    

A retrospective medical chart review of 300 hospitalized non-cystic fibrosis patients (diagnoses unspecified) receiving professionally administered percussion and postural drainage (P&PD) treatments for secretion clearance found that a significant proportion of those treatments could have been effectively replaced with high frequency chest wall oscillation (HFCWO), thus providing a substantial savings in professional time, effort and costs.
  5. Gomez A, Elisan I, Hardy K. Utilization of high frequency chest wall oscillation (Vest therapy) during therapeutic pediatric flexible fiberoptic bronchoscopy. Poster presentation at the 46th International Respiratory Congress of the American Association for Respiratory Care, October 7, 2000, Cincinnati, Ohio, USA.
    

This report of the use of high frequency chest wall oscillation (HFCWO) in three pediatric patients in conjunction with fiberoptic broncoscopy showed marked enhancement of secretion clearance in two of the three during the procedure. No safety concerns were noted.
  6. Gomez A, Elisan I, Hardy K. High frequency chest wall oscillation: video documentation of effect on a patient with Duchenne muscular dystrophy and severe scoliosis. Presented at the 46th International Respiratory Congress of the American Association for Respiratory Care, October 7, 2000, Cincinnati, Ohio, USA.

    
A 16 year-old Duchenne muscular dystrophy patient with severe kyphoscoliosis and deteriorating respiratory health had persistent atelectasis and mucus plugging unresponsive to both manual chest physiotherapy (CPT) and therapeutic bronchoscopy. A subsequent bronchoscopy performed while the patient received high frequency chest wall oscillation (HFCWO) successfully cleared large volumes of secretions. A follow-up videotaped broncoscopy with HFCWO showed healing bronchial mucosa, minimal secretions and significant mobilization for mucus from peripheral lung regions.
  7. Gomez A, Acker R, Buehler C, Newman V, Successful use of high frequency chest wall oscillation in pediatric post operative spinal fusion. Presentation at the 48th International Respiratory Congress of the American Association for Respiratory Care, AARC 2002 Abstract; OF-O2-156.

    
A retrospective hospital chart review is reported for four adolescent spinal fusion patients (idiopathic scoliosis) in a pediatric intensive care unit (PICU) who received high frequency chest wall oscillation (HFCWO) 3-5 days post-operatively after failing other airway clearance interventions. Indications were atelectasis with or without pleural effusion and with or without evidence of mucus plugging. All patients had either inadequate cough secondary to post operative pain, an artificial airway for ventilatory support and/or neuromuscular disease. HFCWO was administered for 20-30 minutes every 2-4 hours. Radiographs after 4 days of HFCWO for all patients showed either complete resolution or minimal residual atelectasis.
  8. Ndukwu IM, Shapiro S, Nam AJ, Schumm PL. Comparison of high-frequency chest wall oscillation (HFCWO) and manual chest physiotherapy (mCPT) in long-term acute care hospital (LTAC) ventilator-dependent patients. Chest 1999; 116 (4) Suppl: 311S.
    

This randomized, controlled study of 54 long-term acute care patients who had been ventilator-dependent for a median of 84 days compared chest physiotherapy (CPT) and high frequency chest wall oscillation (HFCWO) as modalities for secretion management. Subjects were randomized to receive either CPT or HFCWO 4 times daily for 15 minutes for 40 days. After 21 days, the HFCWO group produced larger volumes of sputum and, after 40 days, 38 % were weaned from ventilator dependence compared with 15% in the CPT group. No adverse events occurred, suggesting that HFCWO is safe, effective and may promote ventilator weaning.
  9. Whitman J, Van Beusekom R, Olson S, Worm M, Indihar F. Preliminary evaluation of high-frequency chest compression for secretion clearance in mechanically ventilated patients. Respir Care 1993; 38:1081-1087.

    
A comparison of the safety and efficacy of percussion and postural drainage (P&PD) and high frequency chest compression (HFCC) in the treatment of long-term mechanically ventilated patients showed equivalent safety and efficacy; 80% of therapists believed HFCC reduced work load.

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